Johns Hopkins Hospital lost its coveted spot as the nation'stop-ranked hospital for the first time in 22 years, edged out by Boston's Massachusetts General Hospital in the latest analysis by U.S. News & World Report to be released Tuesday.

Hopkins still ranked No. 2, and marketing experts said falling one spot will hurt the hospital's ego more than its reputation.

"It is disappointing, of course, anytime you get knocked off the premiere position," said Ronald R. Peterson, president of Hopkins Hospital and Health System and executive vice president of Johns Hopkins Medicine. "We're going to try to figure out what we can do to reassume that throne."

Peterson said he doesn't think second place will tarnish Hopkins' reputation. After all, Hopkins was at the top for more than two decades, something that Peterson said the hospital will emphasize in its marketing.

"They can't take that away from us," he said.

Peterson pointed out that Hopkins had 15 nationally ranked specialty medical programs. Five are best in the country: neurology and neurosurgery, geriatrics, psychiatry, rheumatology, and ear, nose and throat.

There is no lack of rankings of hospitals, and some mean more than others, those in the industry said. U.S. News & World Report is considered one of the more credible ones because it looks at a variety of criteria, said Ashish Jha, associate professor of health policy and management at the Harvard School of Public Health.

Jha said when you get to the level of Hopkins, a small detail can mean the difference between first and second place.

"I personally don't think it matters whether you're No. 1 or 2 at this level, because as a group they're all terrific hospitals," Jha said.

Avery Comarow, health rankings editor at U.S. News & World Report, said the competition was tight between the top two contenders. Both had 30 honor roll points, the scoring system the publication uses to rank hospitals. Massachusetts General edged out Hopkins because it had 16 nationally ranked specialty programs compared to Hopkins' 15, he said.

"It's not as if Hopkins took a precipitous drop by falling from No. 1 to No. 2," Comarow said. "While any honor roll listing is good for bragging rights, patients need to look at how a hospital performed in the specialties relevant to their medical situation."

U.S. News & World Report uses information from the American Hospital Association to come up with its rankings. The association surveys hospitals and retrieves data from other sources. Criteria include the number of doctors and nurses, the volume of births and emergency room visits, mortality rates and the kinds of medical programs a hospital offers

Comarow said it is hard to tease out where Hopkins' weaknesses may have been because his publication doesn't analyze individual hospitals in detail. The analysis used to compile the rankings has changed in recent years, with more emphasis on clinical outcomes and less on peer review, he said. It is possible that may have affected the rankings.

The University of Maryland Medical Center saw its performance in specialty areas such as cancer and nephrology improve this year, in part because there is more emphasis on outcomes. Jeffrey A. Rivest, president and CEO of the University of Maryland Medical Center, said rankings like this help to solidify the state's reputation for strong health care.

"I think it shows people there are two national-class medical centers in this city," Rivest said. "Perhaps people take that for granted sometimes."

Peter Slavin, the president of Massachusetts General, said his hospital plans to market its new status on its website, but he's unsure whether it will make much of a difference in attracting patients or getting more research money.

"We are thrilled to be considered No. 1," Slavin said. "Having said that, we are also humbled to be included in the ranks of Hopkins, Mayo and our sister institution, the Brigham and Women's Hospital. We're honored with this recognition but need to take it with the appropriate numbers of grains of salt."

Massachusetts General was No. 2 last year.

State officials, who point to Hopkins' reputation as a selling point to businesses and others looking to move to Maryland, say they will continue to do so.

Maryland Economic Development Secretary Christian Johansson said when he has been on trade missions to India, China and other areas of the world, people always know Johns Hopkins. He said it will be hard to unravel the reputation of an institution that has won world renown for research, producing Nobel Prize winners and saving lives.

"Reputation is not built over one year, reputation is built over decades," Johansson said.

"It just means marketing language may have to be more nuanced," said Basu, head of the Sage Policy Group, a firm that consults on Mid-Atlantic economic and policy issues.

Gray said patients start to become immune to rankings because they are advertised so heavily. A person's primary-care physician is more likely to influence what specialists a patient chooses. The rankings are more likely to influence wealthy patients in other countries looking for the best care, he said.

The best measurement isn't a ranking, Peterson said, but how well patients are treated.

"It's not about winning a contest or a survey," he said. "It's about what we do every day to provide our patients with the best care."

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